09/05/2025
Legislation update for direct primary care! Exciting news.
Important Policy Update for Patients and Physicians:
Today’s announcement from CMS marks a significant step forward for patient-centered healthcare. Beginning in 2026, individuals who do not qualify for ACA subsidies will finally have the option to purchase catastrophic coverage on the Marketplace. Until now, this option was largely limited to those under age 30.
When combined with the provisions of the One Big Beautiful Bill Act, this creates a powerful new pathway:
Catastrophic plans will be recognized as HSA-eligible.
Direct Primary Care memberships are explicitly defined as HSA-qualified medical expenses.
Patients will be able to pair a low-cost catastrophic plan with a DPC membership and fund it through an HSA pre-tax.
This combination provides:
Preventive services covered at no cost under the catastrophic plan (mammogram, colonoscopy, birth control, STI screening, Pap tests, vaccines).
Unlimited access to primary care through DPC.
True catastrophic protection with no annual or lifetime coverage limits after the deductible.
For those of us working to advance Direct Primary Care, this is a major policy win. It demonstrates that when policymakers and physicians align around patient needs, we can create solutions that expand access, lower costs, and improve care.
Link to the CMS fact sheet is in the comments.
